Getting the better of tuberculosis
On January 13, India completed seven years without detecting a single case of the wild polio virus. India was once described as one of the most challenging places in the world to eradicate polio. Yet, with visionary and innovative planning, an intensive vaccination campaign and large-scale community engagement, the nation made astounding progress against the disease and was declared polio-free in March 2014.
The key to this success was the involvement of not just the medical fraternity, but also the media, public figures, and community leaders. In a mammoth effort, over two million vaccine administrators identified vulnerable communities, targeted migrant families and traversed enormous distances to immunise children in the most remote regions. Social workers and community leaders were involved in countering misconceptions about the vaccine and encouraging families to vaccinate their children. Outreach efforts were bolstered by the “Do Boond Zindagi Ke” campaign that was widely publicised in the media and endorsed by leading public figures such as Amitabh Bachchan, Sachin Tendulkar and Aishwarya Rai.
The lessons learnt from the polio campaign are enormously relevant in the present battle against tuberculosis (TB). India bears a significant share of the world’s TB burden. In 2016 alone, about 2.79 million new cases of TB were detected in the country and over 420,000 people lost their lives to the disease.
The government has however risen to the challenge TB poses by committing to eliminate the disease by 2025, five years ahead of the targets set by the Sustainable Development Goals. The government has developed the National Strategic Plan for TB Elimination (NSP), which is backed by a budget of over ~120 billion, over three years (2017-20), the highest allocation of resources to fight the disease so far!
The NSP espouses a unique patientcentric approach that aims to reach the unreached in the country. Taking its cue from the polio drive, the government has initiated active case-finding campaigns to reach TB patients in remote areas. These campaigns have already screened over 30 million people and detected over 15,000 additional TB cases. The NSP also assures quality care to every TB patient through the provision of free diagnosis and treatment in the public and private sector, truly universalising coverage.
The disease has devastating economic and social consequences, especially for the poorer sections of society. To protect patients and their families against these catastrophic impacts, the government aims to support patients by a monthly direct cash or “benefit” transfer scheme, and by providing additional nutrition to ensure that they are strong enough to fight TB.
While the NSP is certainly a crucial step in the right direction, the success of India’s elimination efforts will also depend on the ability to identify gaps in the system and address them in mission mode. The translation of astute national policies into on-ground action will be critical to tipping the scales in our favour. Systemic impediments will need a review if we are to overcome lags in fund disbursal to state units, ensure utilisation of funds is timely and manage the procurement of drugs and diagnostics efficiently.
The programme would benefit from better integrating information technology and information management systems in the effort. But technology alone is not the answer, and until our stateand district-level TB officers are empowered with the management skills to steer this monumental and complex programme at their levels, our efforts will be found wanting.
The solution to this public health challenge of course neither starts nor ends with government responsibility alone. Our efforts need to be bolstered by a collective response that actively involves industry, community leaders and the general public. Private sector providers must be brought in to fight shoulder-toshoulder with the public sector. This has already been put to test with Private Providers Service Agency (PPSA) models in Mumbai, Patna and Mehsana. Through the engagement of private providers treating TB patients in these cities, the models were instrumental in drastically improving case notifications to the government and treatment adherence amongst the patients. Leading industry bodies like the Healthcare Federation of India and Ficci’s health committee can facilitate private sector participation in TB control initiatives and assist with determining how the resources available in the private sector may be best utilised to deliver public good.
Celebrities and public figures play a pivotal role in building momentum in public health campaigns. Mr Bachchan as a TB champion has drawn unprecedented public attention to the disease. We need more voices like Tamil cine star Suriya, educationist Anand Kumar and radio jockey Khurafati Nitin to reinforce Mr Bachchan’s call.
With the world looking at India to lead the global response to TB, it is time to replicate our success with polio to eliminate TB from the country.
India bears a significant share of the world’s tuberculosis burden. In 2016 alone about 2.79 mn new cases of TB were detected in the country and over 420,000 people lost their lives to the disease